Bicon Dental Implants
Friday, July 3rd 2009 6:21PM EDT

Full Arch / Short Implants / Bicon Integrated Abutment Crowns™: Two Stage Full Mouth Placement of Twenty-Four Implants and their Restoration with Integrated Abutment Crowns™ (Part 1)
This case demonstrates the two stage full mouth implant placement technique for twenty-four implants including 6.0 x 5.7mm and 5.0 x 6.0mm short implants as well as their restoration with twenty-one Integrated Abutment Crowns™ (IACs) and two intra-orally bonded two-unit cantilever Integrated Abutment Crowns™ (IACs).
Before
Before
Before

After

After

After



 

(NOTE: This is Part One of a two-part case. Click here to view Part Two.)



1.
 Pre-operative radiograph.


2.
 Pre-operative smile.


3.
 Pre-operative facial view.


4.
 Initial incision.


5.
 Surgical template being used to confirm appropriate trajectories.


6.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.


7.
 Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomy.


8.
 Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomy.


9.
 Parallel pins seated in pilot osteotomies indicating their trajectories.


10.
 Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM.


11.
 Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM.


12.
 Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM.


13.
 Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM.


14.
 Harvested bone within the flute of silver 4.5mm latch reamer.


15.
 Harvested bone within the flute of gold 5.0mm latch reamer being placed into dappin dish.


16.
 Osteotomy being enlarged with a blue 5.5mm bone expander attached to a straight handle.


17.
 A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


18.
 A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


19.
 A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


20.
 A 6.0mm x 5.7mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


21.
 A 6.0mm x 5.7mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


22.
 A 6.0mm x 5.7mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


23.
 View of seated implants with polyethylene healing plugs.


24.
 Cut polyethylene healing plug being inserted into the implant well for two stage placement.


25.
 Maxillary right side being sutured after two-stage placement.


26.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.


27.
 Osteotomy being enlarged with a olive green 2.5mm latch reamer rotating at 50 RPM.


28.
 Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM.


29.
 Harvested bone within the flute of red 4.0mm latch reamer.


30.
 Silver 4.5mm hand reamer attached to a straight handle is being rotated to enlarge the osteotomy.


31.
 Blue 5.5mm hand reamer attached to a straight handle is being rotated to enlarge the osteotomy.


32.
 A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


33.
 A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


34.
 Harvested bone within the flute of silver 4.5mm hand reamer fastened to a straight driver.


35.
 A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


36.
 Silver 4.5mm hand reamer attached to a straight handle is being rotated to enlarge the osteotomy.


37.
 A 5.0mm x 6.0 HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


38.
 A 5.0mm x 6.0 HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


39.
 Cut polyethylene healing plug being inserted into the implant well for two stage placement.


40.
 Post-operative view.


41.
 Post-operative radiograph.


42.
 Surgical template being used to confirm appropriate trajectories.


43.
 Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomy.


44.
 Parallel pins seated in pilot osteotomies indicating their trajectories.


45.
 Osteotomy being enlarged with a olive green 2.5mm latch reamer rotating at 50 RPM.


46.
 Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM.


47.
 Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM.


48.
 Osteotomy being enlarged with a silver 4.5mm latch reamer rotating at 50 RPM.


49.
 A 3.5mm x 11.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


50.
 View of osteotomies and a well of seated implant.


51.
 A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


52.
 A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


53.
 A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


54.
 A 3.5mm x 11.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


55.
 View of seated implants with polyethylene healing plugs.


56.
 Mandibular right side sutured after two-stage implant placement.


57.
 Surgical template being used to confirm appropriate trajectories.


58.
 Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy.


59.
 Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomy.


60.
 Osteotomy being enlarged with a olive green 2.5mm latch reamer rotating at 50 RPM.


61.
 Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM.


62.
 Osteotomy being enlarged with a gold 5.0mm latch reamer rotating at 50 RPM.


63.
 Harvested bone within the flute of gold 5.0mm hand reamer being placed into a dappin dish.


64.
 Osteotomy being enlarged with a gold 5.0mm latch reamer rotating at 50 RPM.


65.
 Curette removing residual bone while confirming the integrity of the five bony walls of the osteotomy.


66.
 A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


67.
 View of osteotomies and a well of seated implant.


68.
 A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


69.
 A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


70.
 A 3.5mm x 11.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


71.
 Cut polyethylene healing plug being inserted into the implant well for two stage placement.


72.
 Autogenous bone graft being placed on top of the seated implants.


73.
 Mandibular left side sutured after two-stage placement.


74.
 Post-operative radiograph.


75.
 Two-week post-operative view.


76.
 View of mandibular arch prior to the two-stage uncovering eight weeks after the implant placement.


77.
 Cut polyethylene healing plug being removed from the well of the implant with a #110 file.


78.
 Cut polyethylene healing plug being removed from the well of the implant.


79.
 Cut polyethylene healing plug being removed from the well of the implant.


80.
 View of mandibular right side with guide pins seated in the implant wells.


81.
 View of operative site prior to the extraction of two carious incisors.


82.
 Cut polyethylene healing plug being removed from the well of the implant.


83.
 Parallel pin seated in pilot osteotomy indicating its trajectory.


84.
 Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM.


85.
 Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM.


86.
 Harvested bone within the red 4.0mm latch reamer.


87.
 Osteotomy being enlarged with a silver 4.5mm latch reamer rotating at 50 RPM.


88.
 A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


89.
 View of seated implant with polyethylene healing plug.


90.
 View of the wells of the seated implants.


91.
 Extracted mandibular incisor.


92.
 Extracted mandibular incisor.


93.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.


94.
 Osteotomy being enlarged with a olive green 2.5mm latch reamer rotating at 50 RPM.


95.
 Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM.


96.
 A 3.5mm x 11.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


97.
 Implant seating tip attached to a straight handle is being tapped to seat implant farther into the osteotomy.


98.
 View of seated implants with polyethylene healing plugs.


99.
 Stealth shouldered abutment 4.0mm wide with a shoulder height of 3.5mm is being inserted into the implant well with only finger pressure.


100.
 Tall acrylic sleeve being modified.


101.
 Tall acrylic sleeve being snapped onto stealth abutment.


102.
 Tall acrylic sleeve being snapped onto stealth abutment.


103.
 Transitional composite material, Integrity by Dentsply, being added to acrylic sleeves to form a strut.


104.
 Transitional composite material is being injected into vacuum formed template.


105.
 Transitional prosthesis being formed.


106.
 Transitional prosthesis being removed for polishing.


107.
 View of the removed transitional prosthesis.


108.
 View of the polished transitional prosthesis.


109.
 View of maxillary arch prior to the two-stage uncovering eight weeks after the implant placement.


110.
 View of 3.0mm guide pins and healing plug in the implant wells prior to their removal for the implant level transfer impression.


111.
 Healing plug being removed from the well of the implant.


112.
 Healing plug being removed from the well of the implant.


113.
 Healing plug being removed from the well of the implant.


114.
 View of guide pins seated in the implant wells.


115.
 Stealth shouldered abutment 4.0mm wide with a shoulder height of 1.5mm is being inserted into the implant well with only finger pressure.


116.
 View of maxillary arch with stealth shouldered abutments seated in the implant wells with only finger pressure.


117.
 Tall acrylic sleeve being modified.


118.
 Tall acrylic sleeve being snapped onto stealth abutment.


119.
 Vacuum-formed template seated over acrylic sleeves to confirm the appropriateness of their placement.


120.
 View of mandibular arch with stealth shouldered abutments seated in the implant wells with only finger pressure.


121.
 Tall acrylic sleeve being modified.


122.
 Plane of occlusion being evaluated.


123.
 Vacuum-formed template seated over modified acrylic sleeves to confirm the appropriateness of their placement.


124.
 Further modification of the acrylic sleeve.


125.
 Transitional composite material, Integrity by Dentsply, being added to acrylic sleeves to form a transitional prosthesis.


126.
 Transitional composite material, Integrity by Dentsply, being added to acrylic sleeves to form a transitional prosthesis.


127.
 Transitional composite material is being injected into vacuum-formed template.


128.
 Transitional prosthesis being formed.


129.
 Transitional prosthesis being formed.


130.
 Transitional prosthesis being removed for polishing.


131.
 View of mandibular arch with transitional stealth shouldered abutments prior to the two-stage uncovering of the three anterior implants ten weeks after their placement.


132.
 Initial incision.


133.
 View of seated implants with cut polyethylene healing plugs.


134.
 Healing plug being removed from the well of the implant with a healing plug removal instrument.


135.
 Red plastic temporary abutment being inserted into the well of the implant.


136.
 Flap being sutured.


137.
 Plastic temporary abutments being modified.


138.
 View of modified plastic temporary abutments.


139.
 Transitional prosthesis being snapped onto the temporary abutments.


140.
 View of reinserted transitional prosthesis.


141.
 Post operative radiograph.


142.
 View of implant wells after the removal of the transitional prosthesis and the stealth abutments on the patient’s fourth clinical visit twenty-seven weeks after the initial implant placement.


143.
 View of guide pins seated in the implant wells.


144.
 Green 3.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.


145.
 Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant for the recording an occlusal registration.


146.
 View of seated impression posts on the right side half of the maxillary arch and left side of the stabilizing prosthesis for the recording of an occlusal registration.


147.
 View of transitional abutments prior to their removal.


148.
 Left side of the mandibular stabilizing prosthesis being reinserted for the recording of an occlusal registration.


149.
 Green 3.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.


150.
 Red 2.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.


151.
 Impression post being tapped into place to assure its proper seating.


152.
 View of seated impression posts on the right side.


153.
 Red acrylic on impression posts recording an occlusal registration.


154. After the removal of the left side transitional prosthesis, a green 3.0mm impression reamer is inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.


155. Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant.


156. After the removal of the left side transitional prosthesis, a green 3.0mm impression reamer is inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.


157. Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant.


158. View of seated impression posts and red acrylic on the right side recording the occlusal registration .


159. Red acrylic on impression posts recording an occlusal registration.


160. Occlusal registration being marked to record the midline of the face, lip line and incisal length of anterior teeth.


161. Occlusal registration removed from implant wells.


162. View of implant wells and soft tissue sulci of maxillary arch.


163. View of implant wells and soft tissue sulci of mandibular arch.


164. Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant for the making of an implant-level transfer impression.


165. Impression post being tapped into place to assure its proper seating.


166. Impression material being injected around the impression post for the making of a full arch implant-level transfer impression.


167. Red 2.0mm plastic impression post being inserted into the 2.0mm well of an integrated implant for the making of an implant-level transfer impression.


168. Impression post being tapped into place with an offset driver to assure its proper seating.


169. Impression post being tapped into place to assure its proper seating.


170. Impression material being injected around the impression posts for the making of a full arch implant-level transfer impression.


171. Facial view of seated impression posts prior to their being removed for the reinsertion of the transitional prostheses.


172. Transitional prosthesis reinserted after the making of an implant level impression.


173. Transitional prosthesis reinserted after the making of an implant level impression.


174. Transitional prosthesis reinserted after the making of an implant level impression.


175. Transitional prosthesis reinserted after the making of an implant level impression.


176. Occlusal view of impression posts in mandibular stone model.


177. View of implant analogs in a soft-tissue stone model.


178. Occlusal view of impression posts in maxillary stone model.


179. View of implant analogs in a soft-tissue stone model.


180. View of occlusal registration.


181. View of occlusal registration with stone models.

(NOTE: This is Part One of a two-part case. Click here to view Part Two.)

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